Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Hossam M Moharram, Shaaban Abd-Elhamid Mehany Elwan, Mahmoud M Nassar, Mohamed F Abdelkader, Hossam M Moharram, Shaaban Abd-Elhamid Mehany Elwan, Mahmoud M Nassar, Mohamed F Abdelkader

Abstract

Purpose: One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions.

Methods: 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study.

Results: The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P < 0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P < 0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period.

Conclusions: This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Hossam M. Moharram et al.

Figures

Figure 1
Figure 1
The mean BCDVA changes in LogMAR.
Figure 2
Figure 2
Intraocular pressure changes overtime.

References

    1. Allingham R. R., Damji K. F., Freedman S., et al. Shields’ Textbook of Glaucoma. 5th. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2005.
    1. An T.-S., Kwon S.-I. Neovascular glaucoma due to branch retinal vein occlusion combined with branch retinal artery occlusion. Korean Journal of Ophthalmology. 2013;27(1):64–67. doi: 10.3341/kjo.2013.27.1.64.
    1. Weiss D. I., Shaffer R. N., Nehrenberg T. R. Neovascular glaucoma complicating carotid-cavernous fistula. Archives of Ophthalmology. 1963;69(3):304–307. doi: 10.1001/archopht.1963.00960040310007.
    1. Moraczewski A. L., Lee R. K., Palmberg P. F., Rosenfeld P. J., Feuer W. J. Outcomes of treatment of neovascular glaucoma with intravitreal bevacizumab. British Journal of Ophthalmology. 2009;93(5):589–593. doi: 10.1136/bjo.2008.151472.
    1. Nakatake S. Hyphema is a risk factor for failure of trabeculectomy in neovascular glaucoma: a retrospective analysis. BMC Ophthalmology. 2014;14(1):p. 55. doi: 10.1186/1471-2415-14-55.
    1. Fong A. W., Lee G. A., O’Rourke P., Thomas R. Management of neovascular glaucoma with transscleral cyclophotocoagulation with diode laser alone versus combination transscleral cyclophotocoagulation with diode laser and intravitreal bevacizumab. Clinical & Experimental Ophthalmology. 2011;39(4):318–323. doi: 10.1111/j.1442-9071.2010.02449.x.
    1. Yalvac I. S., Eksioglu U., Satana B., Duman S. Long-term results of Ahmed glaucoma valve and Molteno implant in neovascular glaucoma. Eye. 2007;21(1):65–70. doi: 10.1038/sj.eye.6702125.
    1. Shchomak Z. Surgical treatment of neovascular glaucoma: a systematic review and meta-analysis. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2019;257(6):1079–1089. doi: 10.1007/s00417-019-04256-8.
    1. Artini W., Gracia A., Kekalih A., Oktariana V. D., Victor A. A., Bani A. P. Intravitreal antivascular endothelial growth factor injection combined with panretinal photocoagulation for neovascular glaucoma in Indonesian patients with diabetes mellitus: a prospective study. Medical Journal of Indonesia. 2019;28(3):258–267. doi: 10.13181/mji.v28i3.2865.
    1. Olmos L. C., Lee R. K. Medical and surgical treatment of neovascular glaucoma. International Ophthalmology Clinics. 2011;51(3):27–36. doi: 10.1097/iio.0b013e31821e5960.
    1. Elmekawey H., Khafagy A. Intracameral ranibizumab and subsequent mitomycin C augmented trabeculectomy in neovascular glaucoma. Journal of Glaucoma. 2014;23(7):437–440. doi: 10.1097/ijg.0b013e3182946398.
    1. Kuzmin A., Lipatov D., Chistyakov T., et al. Vascular endothelial growth factor in anterior chamber liquid patients with diabetic retinopathy, cataract, and neovascular glaucoma. Ophthalmology and Therapy. 2013;2(1):41–51. doi: 10.1007/s40123-013-0014-3.
    1. Marey H. M., Ellakwa A. F. Intravitreal bevacizumab with or without mitomycin C trabeculectomy in the treatment of neovascular glaucoma. Clinical Ophthalmology (Auckland, NZ) 2011;5:p. 841. doi: 10.2147/OPTH.S21453.
    1. Saito Y., Higashide T., Takeda H., Ohkubo S., Sugiyama K. Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma. Acta Ophthalmologica. 2010;88(1):96–102. doi: 10.1111/j.1755-3768.2009.01648.x.
    1. Takihara Y., Inatani M., Kawaji T., et al. Combined intravitreal bevacizumab and trabeculectomy with mitomycin C versus trabeculectomy with mitomycin C alone for neovascular glaucoma. Journal of Glaucoma. 2011;20(3):196–201. doi: 10.1097/ijg.0b013e3181d9ce12.
    1. Takihara Y. Combined intravitreal bevacizumab and trabeculectomy with mitomycin C versus trabeculectomy with mitomycin C for neovascular glaucoma. Investigative Ophthalmology & Visual Science. 2009;50(13):p. 174.
    1. Chen C.-W., Huang H.-T., Bair J.-S., Lee C.-C. Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma. Journal of Ocular Pharmacology and Therapeutics. 1990;6(3):175–182. doi: 10.1089/jop.1990.6.175.
    1. Nilforushan N., Yadgari M., Kish S. K., Nassiri N. Subconjunctival bevacizumab versus mitomycin C adjunctive to trabeculectomy. American Journal of Ophthalmology. 2012;153(2):352–357. doi: 10.1016/j.ajo.2011.08.005.
    1. Kinoshita N. Surgical results of pars plana vitrectomy combined with pars plana lensectomy with anterior capsule preservation, endophotocoagulation, and silicon oil tamponade for neovascular glaucoma. Clinical Ophthalmology (Auckland, NZ) 2011;5:p. 1777. doi: 10.2147/OPTH.S26241.
    1. Li X.-J., Yang X.-P., Li Q.-M., Wang Y.-Y., Lyu X.-B. Ranibizumab plus combined surgery for treatment of neovascular glaucoma with vitreous hemorrhage. Chinese Medical Journal. 2015;128(15):2078–2083. doi: 10.4103/0366-6999.161371.
    1. Kolomeyer A. M., Seery C. W., Emami-Naeimi P., Zarbin M. A., Fechtner R. D., Bhagat N. Combined pars plana vitrectomy and pars plana Baerveldt tube placement in eyes with neovascular glaucoma. Retina. 2015;35(1):17–28. doi: 10.1097/iae.0000000000000235.
    1. Demircan A. Neovasküler glokomda intravitreal bevacizumab, Pan retinal fotokoagülasyon ve diyot lazer siklodestrüksiyon kombine tedavisi. Turkiye Klinikleri Journal of Ophthalmology. 2019;28(3):161–166. doi: 10.5336/ophthal.2018-63268.

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